If you are like the millions of people suffering from heartburn at night, you probably dread laying down each night fearing what your night will bring. Nighttime heartburn can also be accompanied by other painful symptoms, such as coughing, choking, regurgitation, sore throat and even chronic sinus issues.
People searching for relief at night often turn to OTC or prescription acid-reducing medications, which work for some but not for others. With the recent research linking such medications to serious side effects, such as bone fractures, kidney failure, heart disease, pneumonia, Clostridium difficile and most recently dementia and Alzheimer’s, many people are searching for natural treatments for nighttime reflux.
Natural treatments for nighttime heartburn
The only two clinically validated natural treatments for GERD are weight loss and sleep positioning. Though weight loss can be effective, it is often a longer-term solution that, depending on how much weight you need to lose, can take months before relief is felt. Sleep positioning, on the other hand, can make a huge difference for those suffering from nighttime GERD and relief can be often experienced almost immediately.
Sleep positioning for natural relief
Many people don’t realize that how you sleep directly affects how you reflux at the night as anatomy and gravity play a big role in heartburn symptom frequency, length and severity.
First, a quick anatomy lesson. What you eat travels down your esophagus through your lower esophageal sphincter (LES) and into your stomach where digestion begins. Your LES is essentially a ring of muscles that act as a valve to control the flow of contents between your esophagus and your stomach and vice versa. If your LES functions correctly, what you eat will stay in your stomach with the occasional release of gas, also known as a burp. Problems arise when your LES doesn’t function properly allowing your stomach contents to escape back up into your esophagus. Commonly referred to as reflux, the acidic nature of what comes back up can cause damage to the delicate lining of your esophagus leading to serious health complications, such as erosive esophagitis, peptic stricture, esophageal ulcerations, Barrett’s esophagus, and adenocarcinoma of the esophagus1.
If reflux occurs when you are standing up, gravity and saliva quickly return the acidic content to your stomach. This quick return typically makes your symptoms shorter, as well as minimizes the potential acid damage to the delicate lining of your esophagus from acid exposure. (Figure 1)
Things get more complicated when you lay down to sleep at night as saliva and swallowing slow making the return of reflux to the stomach more difficult2. Let’s take a look at common sleep positions and you will quickly see which ones you will want to avoid!
Nighttime heartburn can be tough for back sleepers making it position #1 to avoid at night. When laying flat on your back, a poorly functioning LES can allow acidic stomach contents to flow freely into the esophagus. Studies have shown that in this position, symptoms are often more frequent and tend to last longer3. The severity of your symptoms may also increase if you have stomach fat, which pushes down on your stomach and LES and can “force” contents back up into the esophagus and beyond. To reduce your nighttime heartburn and decrease the risks associated with prolonged acid exposure, try to stay off your back at night. (Figure 2)
Position #2 to avoid at night is…sleeping flat on your right side. Though episodes may be less frequent on your right when compared to flat on your back, the episodes are much more liquid in nature because your LES is often submerged in the acidic stomach content4. This position potentially creates a leaky faucet spouting stomach acid into the delicate lining of your esophagus. While liquid reflux can be very distressing, it can also be dangerous as when flat on your right side, the amount of time acid lingers in your esophagus is much longer3. Gravity is fighting an uphill battle as it is unable to effectively return refluxed content to your stomach. If you suffer from nighttime heartburn, avoid laying flat on your right side. (Figure 3)
You may have heard that sleeping flat on your left side provides heartburn relief, which is true! In this position, your LES typically stays above “sea level” or above the level of gastric contents making refluxing more difficult. Should reflux escape, gravity is able to return it to your stomach quicker than when on your right side. Also, reflux on your left side tends to be more gaseous in nature4, which decreases potential damage from acid exposure. Studies have shown that symptoms are less frequent and less severe when on your left side as compared to on your right side or on your back3 making it the most desirable flat sleep position. (Figure 4)
Finally, what about sleeping at an incline? Has your doctor recommended that you sleep at an incline using a bed wedge or putting blocks under your bed frame? Studies have shown that sleeping at an incline decreases the frequency of reflux episodes and allows your body to clear reflux at a quicker rate5. As long as your entire torso is elevated, the incline gives gravity a little boost in its power to return reflux to your stomach.
So, what if you take the best flat sleeping position, aka the left side, and add an incline?
Could the benefits be more than the sum of its parts? Recent studies have shown that this is indeed the case6-7! These studies show that this compound inclined, left-side sleeping position makes refluxing virtually impossible because your LES is now positioned well above the level of stomach contents, even if your stomach is really full. And, if you do reflux, gravity is able to quickly return the contents to your stomach. This ideal relief position provides a double whammy of decreasing your heartburn symptoms and providing protection from prolonged acid exposure to your esophagus, throat, lungs and sinuses. (Figure 5)
If you want to experience the power of this compound position, try an Acid Reflux Pillow System by MedCline, specifically designed to create and maintain the position clinically proven to be the most effective for natural relief from nighttime heartburn and the other distressing symptoms of acid reflux/GERD. Sweet dreams!
- Lagergren, J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340: 825-831.
- Fass, Ronnie. ‘PPI bashing’ drives use of alternatives. gastroendnews.com, Sept. 2011.
- Khoury, Ramez M. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with Gastroesophageal Reflux Disease. The American Journal of Gastroenterology. Vol. 94, No. 8, 1999.
- Shay SS, Conwell DL, Mehindru V, et al. The effect of posture on gastroesophageal reflux event frequency and composition during fasting. Am J Gastroenterology. 1996; 91: 54-60.
- Stanciu C, Bennett JR: Effect of posture on gastro-oesophageal reflux, Digestion 1977, 15: 104-109
- Person, E, Freeman, J, Rife, C, Clark, A, Castell, DO. A Novel Sleep Positioning Device Reduces Gastroesophageal Reflux: A Randomized Controlled Trial. Journal of Clinical Gastroenterology. 2015 Sep; 49 (8): 655-9.
- Allampati SK, Lopez R, Ray M, Birgisson S, Gabbard SL. Use of a Sleep Positioning Device Significantly Improves Nocturnal Gastroesophageal Reflux Symptoms. Am J Gastroenterol 2014; 109: S1–S39.